What is Mohs Surgery?
Mohs surgery is a microscopically guided procedure for skin cancer removal. It was developed more than 60 years ago by Frederick Mohs (pronounced 'moze'), a medical student at the University of Wisconsin. Since that time, the technique has been advanced and refined. Today, it is widely accepted as the most accurate cure for skin cancer in cosmetically sensitive areas and for certain other hard to treat skin cancers.
Who Performs Mohs Surgery?
Our practice has two highly trained experts in Mohs surgery on staff. Dr. Lehrer completed a fellowship in skin cancer at the University of Pennsylvania, then went on to a fellowship in Mohs surgery and procedural dermatology at the Dermatologic SurgiCenter. He currently serves as a Clinical Assistant Professor of Dermatology at the University of Pennsylvania School of Medicine and is a volunteer instructor in dermatologic surgery for the VA Hospital.
Dr. Halpern completed his residency training in dermatology at St. Luke’s-Roosevelt Hospital Center/Columbia University, then went on to a two-year fellowship in Mohs Micrographic Surgery and Cutaneous Oncology at Columbia Presbyterian Medical Center/Columbia University. He is board certified in dermatology.
What are the Advantages of Mohs Surgery?
Though most of a skin cancer is usually visible to the naked eye, microscopic 'roots' or 'branches' may extend outside of the central tumor. If these extensions are not removed, the skin cancer may reappear. To guarantee removal of these microscopic areas, most physicians must remove a wide area of normal skin around the visible skin cancer. Even with this safety margin, skin cancers removed with traditional treatments may frequently return or require additional surgical procedures.
In Mohs Surgery, the tumor-removal process is tracked microscopically. We are therefore able to best ensure that the entire skin cancer is removed, while at the same time remove as little normal, healthy skin as possible. This is particularly important in cosmetically sensitive areas. Of course, any procedure will leave a scar, but preserving the maximum amount of healthy skin offers the best possible cosmetic result.
How Large Will the Wound Be?
The size and shape of the wound depends upon the extent of the skin cancer. Though this cannot be predicted before surgery, it is typically at least somewhat wider than the visible skin cancer
How is Mohs Surgery Performed?
Mohs surgery is performed in our office on an outpatient basis. First, local anesthesia is used to numb the tumor site. Then, a thin layer of skin is removed, processed in our office, and examined under the microscope by Dr. Lehrer or Persichetti. If any cancer cells remain, their locations are carefully diagrammed on a map. Using this map as a guide, another thin layer of skin will then be removed. Depending on the branching pattern of the tumor, this process may be repeated several times.
How Will the Wound be Repaired?
In some areas of the face, small wounds may look best if allowed to heal on their own. Most defects, however, require at least a few small stitches. Larger wounds may need skin flaps or grafts. Both techniques involve moving healthier skin into the surgical wound. Unusually large or complicated tumors may, however, require consultation with another subspecialist. Unfortunately, the type of repair needed for your wound cannot be determined until the entire skin cancer is removed. Remember - the primary reason for Mohs Surgery is to cure the skin cancer. Once this is completed, your doctor and our staff will help you to achieve the best cosmetic outcome possible.
How Long Will it Take?
Each stage of surgical sampling takes only about 5-10 minutes, though an additional 1-2 hours is then needed to process and evaluate your specimen. Depending on the extent of your skin cancer, this cycle may need to be repeated several times throughout the day until your entire tumor is removed. In most cases, your doctor will repair your wound immediately following surgery. Depending on the complexity, this step may take between 15 minutes and 1 hour. Because we cannot predict the size of your skin cancer before surgery, it is impossible to determine how long the process may take. Please plan to spend the entire day with us. Hopefully, we will have you home much sooner.
Will I Need to Come Back?
Usually, only one return visit is needed to remove stitches or examine the healing surgical site. Afterwards, it is essential that you return to your referring physician for routine skin examinations.
What are the Risks of Mohs?
- Scarring: A scar will always occur from surgery. Mohs surgery should, however, result in the smallest possible scar. In most cases, scars begin as pink and bumpy and then fade slowly. Occasionally, minor procedures are used to improve the scar.
- Bleeding: Though more extensive bleeding is always possible, very minor bleeding during surgery is expected.
- Pain: During surgery, pain is limited to the initial needles needed to introduce local anesthesia. Following surgery, most patients experience minor discomfort which can be controlled by Tylenol.
- Infection: Infection following surgery may occur. If an area does become infected, it can usually be controlled by oral antibiotics.
- Nerve Damage: Rarely, your skin cancer may be located around a small nerve. If this does happen, the skin surrounding your surgery site may be numb. In rare cases, your skin cancer may surround a nerve that leads to a muscle. If this nerve is damaged, movement of this muscle may be permanently impaired.
- Recurrence: Mohs surgery offers the highest cure rate of all skin cancer treatments. Medicine is, however, an imperfect science. Rarely, a tumor may reappear within the treated area.
How Should I Prepare for Surgery?
- Medicines: Continue to take all medications as prescribed by your physician. Be sure to take all of your medications on the morning of surgery, and bring any doses that you take during the day with you to our office.
- Alcohol: Alcohol may also cause increased bleeding. Please avoid alcohol for one day prior to surgery and two days after surgery.
- Transportation: We suggest that you have a companion drive you to and from our office. You may also be more comfortable with someone to keep you company in the waiting room.
- Meals: On the day of surgery, eat your normal breakfast. We suggest that you bring lunch with you.
Please contact us at 610-594-6660 to learn more about Mohs Surgery or to schedule an appointment.